The Solution: Speech Therapy In The Outskirts Of Bangkok And Rural Thailand

 “We have been looking for a speech therapist to work with our child for over four years now. It’s incredibly frustrating that we can’t find one because of where we live.”
– Anonymous parents living in the outskirts of Bangkok.
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In Thailand, as in most countries, there are inequities between children living in rural and urban areas when accessing speech therapy. Even children living in the outskirts of Bangkok often do not have access to speech therapy. This is primarily due to the shortage of speech therapists living in rural areas, or who are willing to travel long distances or in dense traffic to provide services.

I am frequently contacted by parents living in the outskirts of Bangkok or in rural Thailand who have this concern. Many children living in rural Thailand do not receive the therapy they need for several years- and in some cases, not at all. This is a huge problem when scientific research has repeatedly demonstrated the importance of early intervention for the best outcomes. It is also problematic when the evidence has shown that children with speech and language delays are likely to experience educational, social, emotional and employment difficulties.

So, does this mean that only children living within central Bangkok will ever have the opportunity to access speech therapy?

Not necessarily.

Especially if there is an openness to other forms of therapy which surpass the ‘traditional therapy model’, where the therapist and child are together in the same room during therapy. In fact, there is an increasingly popular solution to overcome these barriers. Let me tell you about ‘Teletherapy’.
 
What is Teletherapy?
Teletherapy involves the use of communicative technology to provide speech therapy services, such as video-conferencing, email and telephone.
 
What do parents think?
Most parents are more comfortable and familiar with traditional in-person therapy. However, some parents would prefer that their child receives a non-traditional form of therapy than receive no therapy at all. Undoubtedly, this is better for any child’s development.

Parents might be reluctant to try Teletherapy at first. The common misconception is that Teletherapy will not be as effective as traditional therapy. However, scientific research has proven that this is not the case.
 
What does the research say?
Teletherapy has been widely used to assess, diagnose, provide treatment and support to children and their families [1]. Scientific research has proven that teletherapy results in similar outcomes for both diagnosis and treatment when compared to traditional in-person therapy [2].

Teletherapy can also be a sustainable solution on a wider scale, for instance, if it is used in schools located in rural areas in Thailand. A recent Australian study investigated the effectiveness of Teletherapy in school settings [3]. The findings of this study showed that most of the goals outlined for the children receiving teletherapy at school were achieved at the level expected or beyond [3].
 
Why Teletherapy?
Here are some benefits of Teletherapy:

1.      Greater Practice Opportunities:
While traditional in-person therapy emphasizes the interaction between the child and therapist, Teletherapy places a focus on parents as the primary support for speech and language development. Since parents become the focus of the intervention, the opportunities for practice become endless.
 
In a recent Australian study, when speaking about traditional in-person therapy, one parent reported, “I would often end up in a room with speech therapists, occupational therapists or teachers …I don’t think there’s a lot aimed at being a parent and supporting your child [4].” Teletherapy overcomes this concern by putting the parent at the centre of the intervention process and empowering them to support their child.
 
2.      Flexible Consultation Time:
When using Teletherapy, parents have the flexibility to attend consultations while their children are at school. They are no longer limited to the short window between their child finishing school and the therapy centre closing, as is often the case with traditional in-person consultations.
 
3.      Reduced Travel Time:
Children and parents can become extremely tired after traveling long-distances- or being stuck in traffic over short distances such as in Bangkok. Similarly, therapists also can become tired when traveling long distances, which may impact on the frequency of the visits arranged [5]. Teletherapy eliminates the need for parents, children and therapists to travel for consultations.
 
4.      Reduced Cost:
As travel is no longer necessary, Teletherapy removes travel costs for families and therapists.
 
5.      Wide Applicability:
Teletherapy is now being used in the assessment and treatment of many areas of speech and language delays and communication disorders [3]. These include articulation, Autism, cognitive-communication disorders such as after traumatic brain injury, language delay, stuttering, voice disorders and swallowing difficulties.
 
Teletherapy is an excellent solution to increase the accessibility of speech therapy, regardless of geographical location. The outcomes of Teletherapy have been proven similar to those of traditional in-person therapy. I hope that moving forward, more parents living in the outskirts of Bangkok or in rural Thailand will consider this option for their child.


References
Acknowledgement and thanks to the following sources whereby the above information was obtained:
[1] Reynolds, A. L., Vick, J., & Haak, N. J. (2009). Tele-health applications in speech-language pathology: Journal of Telemedicine and Telecare, 15, 310-316.
[2] Edwards, M., Stredler-Brown, A., & Todd, K. (2012). Expanding use of tele-practice in speech-language pathology and audiology. The Volta Review, 112, 227.
[3] Fearweather, C., Lincoln, M., & Ramsden, R. (2016). Speech-language pathology teletherapy in rural and remote educational settings: Decreasing service inequities. International Journal of Speech-Language Pathology, 18, 592-602.
 [4] Anderson, K. L., Balandin, S., & Stancliffe, R. J. (2015). Alternative service delivery models for families with a new speech-generating device: Perspectives for parents and therapist. International Journal of Speech Language Pathology, 17, 185-195.
[5] Dew, A., Vietch, C., Lincoln, M., Brentnall, J., Bulkeley, K., Gallego, G., et al. (2012). The need for new models for delivery of therapy interventions to people with a disability in rural and remote areas of Australia. Journal of Developmental Disability, 37, 50-53.​

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